Cross-Talk between Inflammation, Coagulation/Fibrinolysis and Vascular access in Hemodialysis Patients

Abstract

This work aimed to study the association between fibrinolytic/endothelial cell function and inflammatory markers in chronic kidney disease (CKD) patients undergoing hemodialysis (HD) and recombinant human erythropoietin (rhEPO) therapies, and its relationship with the type of vascular access (VA) used for the HD procedure. As fibrinolytic/endothelial cell function markers we evaluated plasminogen activator inhibitor type-1 (PAI-1), tissue plasminogen activator (tPA) and D-dimers, and as inflammatory markers; C-reactive protein (CRP), soluble interleukin (IL)-2 receptor (s-IL2R), IL-6 and serum albumin levels. The study was performed in 50 CKD patients undergoing regular HD, 11 with a central venous dialysis catheter (CVC) and 39 with an arteriovenous fistula (AVF), and in 25 healthy controls. Compared to controls, CKD patients presented with significantly higher levels of CRP, s-IL2R, IL-6 and D-dimers, and significantly lower levels of PAI-1. The tPA/PAI-1 ratio was significantly higher in CKD patients. We also found statistical significant correlations in CKD patients between D-dimerslevels and inflammatory markers: CRP, albumin, s-IL2R and IL-6. When comparing the two groups of CKD patients, we found that those with a CVC presented statistically significant lower levels of hemoglobin concentration and albumin, and higher levels of CRP, IL-6, D-dimers and tPA. Our results showed an association between fibrinolytic/ endothelial cell function and increased inflammatory markers in CKD patients. The increased levels of Ddimer, tPA and inflammatory markers in CKD patients using a CVC, led us to propose a relationship between the type of VA chosen for HD, and the risk of thrombogenesis.

Major Determinants of BMP-2 Serum Levels in Hemodialysis Patients

“…11 In our study, both groups presented higher levels of IL-6 and PCR (although without reaching statistical significance), but were associated with lower levels of hepcidin, when compared with patients with AVF and responders to rhEPO, respectively. Both the groups needed higher doses of rhEPO, suggesting that rhEPO could have contributed to downregulate hepcidin.…”

TLR4 and TLR9 Polymorphisms Effect on Inflammatory Response in End-Stage Renal Disease Patients

“…Circulating bacterial-derived DNA fragments commonly exist in the blood of ESRD patients under HD. These short derived DNA fragments from microorganisms could be present in solutions used in HD, namely in dialysis fluid, and, as they can cross the dialyzer membranes through retro-filtration, they may get into the bloodstream (27) and induce an inflammatory response in ESRD patients.…”

Malnutrition, Inflammation and Reverse Epidemiology in Hemodialysis Patients

“…In regards to chronic inflammation, changing vascular access type from a catheter to AVG was shown to cause an increase in albumin, where as a change from AVG to catheter caused a decrease in albumin (Wystrychowski, et al, 2009). Similarly, catheter and AVG use have been demonstrated to result in elevated levels of CRP and IL-6 and lower levels of albumin than AVF (Costa, et al, 2008;Movilli, et al, 2006). Thus, the type of vascular access has an impact on inflammation levels.…”

“…Kaysen (2009) indicates that the type of vascular access used in dialysis, the insertion of the catheters, biofilm on catheters, bacterial components present in dialysate, and water supply can all be sources of inflammation (Kaysen, 2009). Markers of inflammation associated with vascular access alone include albumin (Chand, Teo, Fatica, & Brier, 2008;Wystrychowski et al, 2009), CRP (Costa et al, 2008;Movilli et al, 2006;Sachdeva, Kovalchuk, Bitzer, & Mokrzycki, 2009), and IL-6 (Costa, et al, 2008;Sachdeva, et al, 2009). As Kaysen (2009) points out, the type of vascular access in HP is associated with mortality (Xue, Dahl, Ebben, & Collins, 2003).…”